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Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels

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Suhui Li, Patricia Pittman, Xinxin Han and Timothy John Lowe

Objective: This study examines nurse-related clinical nonlicensed personnel (CNLP) in U.S. hospitals between 2010 and 2014, including job categories, trends in staffing levels, and the possible relationship of substitution between this group of workers and registered nurses (RNs) and/or licensed practical nurses (LPNs).

Data Source: We used 5 years of data (2010–2014) from an operational database maintained by Premier, Inc. that tracks labor hours, hospital units, and facility characteristics.

Study Design: We assessed changes over time in the average number of total hours worked by RNs, LPNs, and CNLP, adjusted by total patient days. We then conducted linear regressions to estimate the relationships between nurse and CNLP staffing, controlling for patient acuity, volume, and hospital fixed effects.

Principal Findings: The overall use of CNLP and LPN hours per patient day declined from 2010 to 2014, while RN hours per patient day remained stable. We found no evidence of substitution between CNLP and nurses during the study period: Nurse-related CNLP hours were positively associated with RN hours and not significantly related to LPN hours, holding other factors constant.

Conclusions: Findings point to the importance of examining where and why CNLP hours per patient day have declined and to understanding of the effects of these changes on outcomes.